Clinical study of ultrasonic debridement combined with autolytic debridement in the treatment of diabetic foot ulcers_West China Medical Journal

Authors：

CHANG Chunlei , QI Xiaoxia , CHEN Shihong ,  CAI Yunmin

Wound Diagnosis and Treatment Center, Jinshan Hospital of Fudan University, Shanghai 201508, P. R. China;

Corresponding?author：

CAI Yunmin, Email: cymajj@126.com

Keywords：

Diabetic foot ulcers; Ultrasound debridement; Autolytic debridement; Curative effect

DOI：

10.7507/1002-0179.202102071

Video：

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Objective To explore the clinical efficacy of ultrasound debridement combined with autolytic debridement in the treatment of diabetic foot ulcers.Methods A total of 60 diabetic foot ulcers patients who were diagnosed and treated in Jinshan Hospital of Fudan University from April 2019 to April 2020 were enrolled in the study and randomly divided into two groups, with 30 cases in each group. The trial group received autolytic cleansing combined with ultrasound debridement treatment, and the control group only received autolytic debridement treatment. The baseline conditions, wound treatment efficacy, number of dressing changes, length of hospital stay, treatment cost, wound healing time, wound shrinkage rate, and the time required for the wound to turn into 100% red granulation were compared between the two groups.Results There was no statistically significant difference in gender, age, duration of diabetes or Wagner grade of diabetic foot between the two groups (P>0.05). The efficacy of wound healing in the trial group was better than that in the control group (Z=?2.146, P=0.032). The number of dressing changes [(11.76±2.23) vs. (17.34±4.43) times] and the length of stay [(18.03±3.73) vs. (25.43±4.43) d] in the trial group were lower than those in the control group, and the differences were statistically significant (P<0.05). The difference in treatment cost between the two groups was not statistically significant (P>0.05). The wound healing time of the trial group [(48.43±18.34) vs. (65.24±19.62) d], the wound shrinkage rate [(78.35±8.34)% vs. (56.53±6.54)%] and the time required for the wound to turn into 100% red granulation [(16.34±2.42) vs. (24.55±3.23) d] were better than those of the control group, and the differences were statistically significant (P<0.05). During the treatment process, no patient in the trial group had wound bleeding and had difficulty in stopping bleeding during ultrasonic debridement, and no patient had intolerable pain related to ultrasonic debridement. No patients in either group withdrew early.Conclusions Ultrasound debridement combined with autolytic debridement can effectively improve the curative effect of patients with diabetic foot ulcers and shorten the wound healing time. Therefore, it is worthy of promotion and application in the wound care of patients with diabetic foot ulcers.

Citation： CHANG Chunlei, QI Xiaoxia, CHEN Shihong, CAI Yunmin. Clinical study of ultrasonic debridement combined with autolytic debridement in the treatment of diabetic foot ulcers. West China Medical Journal, 2021, 36(4): 461-464. doi: 10.7507/1002-0179.202102071 Copy

1.	Lázaro-Martínez JL, álvaro-Afonso FJ, García-álvarez Y, et al. Ultrasound-assisted debridement of neuroischaemic diabetic foot ulcers, clinical and microbiological effects: a case series. J Wound Care, 2018, 27(5): 278-286.
2.	Michailidis L, Bergin SM, Haines TP, et al. Healing rates in diabetes-related foot ulcers using low frequency ultrasonic debridement versus non-surgical sharps debridement: a randomised controlled trial. BMC Res Notes, 2018, 11(1): 732.
3.	Campitiello F, Mancone M, Corte AD, et al. An evaluation of an ultrasonic debridement system in patients with diabetic foot ulcers: a case series. J Wound Care, 2018, 27(4): 222-228.
4.	Wang R, Feng Y, Di B. Comparisons of negative pressure wound therapy and ultrasonic debridement for diabetic foot ulcers: a network meta-analysis. Int J Clin Exp Med, 2015, 8(8): 12548-12556.
5.	馬艷敏. 超聲清創術聯合封閉負壓引流術在糖尿病足潰瘍中的臨床應用. 實用糖尿病雜志, 2020, 16(3): 109-110.
6.	Swanson T, Lázaro-Martínez JL, Braumann C, et al. Ultrasonic-assisted wound debridement: report from a closed panel meeting. J Wound Care, 2020, 29(2): 128-135.
7.	何夢龍, 葉琪毅, 邱志輝, 等. 超聲清創刀結合美寶燒傷膏治療糖尿病足潰瘍創面的療效觀察. 云南醫藥, 2020, 41(4): 352-353, 359.
8.	Michailidis L, Bergin SM, Haines TP, et al. A systematic review to compare the effect of low-frequency ultrasonic versus nonsurgical sharp debridement on the healing rate of chronic diabetes-related foot ulcers. Ostomy Wound Manage, 2018, 64(9): 39-46.
9.	何靈杰, 崔含, 黃廣英, 等. 封閉式負壓引流聯合超聲清創術治療糖尿病足的效果. 廣東醫學, 2018, 39(增刊1): 195-197.
10.	秦慧, 徐芬芳, 黃成龍, 等. 超聲清創對肛瘺術后換藥的效果觀察. 中西醫結合研究, 2017, 9(4): 198-199, 202.
11.	梁渝捷, 陳大偉, 文曉蓉, 等. 聯合應用自體富血小板凝膠與 β 受體阻滯劑成功治愈缺血性糖尿病足潰瘍 1 例報告. 四川大學學報(醫學版), 2020, 51(4): 582-586.
12.	Kamineni S, Huang C. The antibacterial effect of sonication and its potential medical application. SICOT J, 2019, 5: 19.
13.	張嘉鵬, 陳佩儀, 趙子煜. 超聲清創對糖尿病足治療效果的 Meta 分析. 循證護理, 2018, 4(5): 389-393.
14.	中國醫療保健國際交流促進會糖尿病足病分會, 國際血管聯盟中國分部糖尿病足病專家委員會. 中國糖尿病足診治指南. 中國臨床醫生雜志, 2020, 48(1): 19-27.
15.	趙勁民, 李剛. 脛骨橫向骨搬移技術治療糖尿病足的專家共識(2020). 中國修復重建外科雜志, 2020, 34(8): 945-950.
16.	Nguyen TT, Ding D, Wolter WR, et al. Validation of matrix metalloproteinase-9 (MMP-9) as a novel target for treatment of diabetic foot ulcers in humans and discovery of a potent and selective small-molecule MMP-9 inhibitor that accelerates healing. J Med Chem, 2018, 61(19): 8825-8837.
17.	柯瑜君, 陳鷺, 林文謙, 等. 右美托咪定局部用藥對糖尿病足患者羅哌卡因坐骨神經阻滯半數有效濃度的影響. 福建醫科大學學報, 2020, 54(3): 192-195.
18.	何夢龍, 葉琪毅, 劉文革, 等. 超聲清創聯合濕潤包扎在糖尿病足保肢治療中效果研究. 中國現代藥物應用, 2020, 14(7): 62-63.
19.	何夢龍, 葉琪毅, 劉文革, 等. 超聲清創聯合負壓引流技術治療糖尿病足潰瘍臨床分析. 嶺南急診醫學雜志, 2020, 25(2): 181-183.
20.	Bajpai A, Nadkarni S, Neidrauer M, et al. Effects of non-thermal, non-cavitational ultrasound exposure on human diabetic ulcer healing and inflammatory gene expression in a pilot study. Ultrasound Med Biol, 2018, 44(9): 2043-2049.
21.	吳顯惠. 超聲清創在糖尿病足病換藥中的應用. 名醫, 2020(10): 214-215.
22.	Esposito S, De Simone G, Gioia R, et al. Deep tissue biopsy vs. superficial swab culture, including microbial loading determination, in the microbiological assessment of skin and soft tissue infections (SSTIs). J Chemother, 2017, 29(3): 154-158.
23.	Koreyba KA, Kudykin MN, Minabutdinov AR. Treatment of wound defects in patients with neuroischemic form of diabetic foot syndrome. Khirurgiia (Mosk), 2015(7): 69-74.
24.	楚偉英, 葉貞, 鄧博, 等. 超聲清創結合局部氧療治療糖尿病足 Wagner2 級創面的效果觀察. 廣東醫科大學學報, 2020, 38(1): 67-69.
25.	林雙, 袁麗, 楊小玲, 等. 超聲水刀聯合負壓滴灌治療在慢性難愈性糖尿病足中的應用效果. 四川醫學, 2019, 40(7): 718-722.
26.	李丙蓉, 侯麗梅, 劉瑤麗, 等. 超聲水刀清創系統聯合封閉式負壓引流沖洗在慢性糖尿病足創面治療中的應用. 解放軍醫藥雜志, 2020, 32(9): 30-33, 43.
27.	籍胤璽, 金毅, 金文波. 封閉式負壓引流聯合超聲清創術治療糖尿病足潰瘍的療效. 中國現代醫學雜志, 2019, 29(1): 108-112.

1. Lázaro-Martínez JL, álvaro-Afonso FJ, García-álvarez Y, et al. Ultrasound-assisted debridement of neuroischaemic diabetic foot ulcers, clinical and microbiological effects: a case series. J Wound Care, 2018, 27(5): 278-286.
2. Michailidis L, Bergin SM, Haines TP, et al. Healing rates in diabetes-related foot ulcers using low frequency ultrasonic debridement versus non-surgical sharps debridement: a randomised controlled trial. BMC Res Notes, 2018, 11(1): 732.
3. Campitiello F, Mancone M, Corte AD, et al. An evaluation of an ultrasonic debridement system in patients with diabetic foot ulcers: a case series. J Wound Care, 2018, 27(4): 222-228.
4. Wang R, Feng Y, Di B. Comparisons of negative pressure wound therapy and ultrasonic debridement for diabetic foot ulcers: a network meta-analysis. Int J Clin Exp Med, 2015, 8(8): 12548-12556.
5. 馬艷敏. 超聲清創術聯合封閉負壓引流術在糖尿病足潰瘍中的臨床應用. 實用糖尿病雜志, 2020, 16(3): 109-110.
6. Swanson T, Lázaro-Martínez JL, Braumann C, et al. Ultrasonic-assisted wound debridement: report from a closed panel meeting. J Wound Care, 2020, 29(2): 128-135.
7. 何夢龍, 葉琪毅, 邱志輝, 等. 超聲清創刀結合美寶燒傷膏治療糖尿病足潰瘍創面的療效觀察. 云南醫藥, 2020, 41(4): 352-353, 359.
8. Michailidis L, Bergin SM, Haines TP, et al. A systematic review to compare the effect of low-frequency ultrasonic versus nonsurgical sharp debridement on the healing rate of chronic diabetes-related foot ulcers. Ostomy Wound Manage, 2018, 64(9): 39-46.
9. 何靈杰, 崔含, 黃廣英, 等. 封閉式負壓引流聯合超聲清創術治療糖尿病足的效果. 廣東醫學, 2018, 39(增刊1): 195-197.
10. 秦慧, 徐芬芳, 黃成龍, 等. 超聲清創對肛瘺術后換藥的效果觀察. 中西醫結合研究, 2017, 9(4): 198-199, 202.
11. 梁渝捷, 陳大偉, 文曉蓉, 等. 聯合應用自體富血小板凝膠與 β 受體阻滯劑成功治愈缺血性糖尿病足潰瘍 1 例報告. 四川大學學報(醫學版), 2020, 51(4): 582-586.
12. Kamineni S, Huang C. The antibacterial effect of sonication and its potential medical application. SICOT J, 2019, 5: 19.
13. 張嘉鵬, 陳佩儀, 趙子煜. 超聲清創對糖尿病足治療效果的 Meta 分析. 循證護理, 2018, 4(5): 389-393.
14. 中國醫療保健國際交流促進會糖尿病足病分會, 國際血管聯盟中國分部糖尿病足病專家委員會. 中國糖尿病足診治指南. 中國臨床醫生雜志, 2020, 48(1): 19-27.
15. 趙勁民, 李剛. 脛骨橫向骨搬移技術治療糖尿病足的專家共識(2020). 中國修復重建外科雜志, 2020, 34(8): 945-950.
16. Nguyen TT, Ding D, Wolter WR, et al. Validation of matrix metalloproteinase-9 (MMP-9) as a novel target for treatment of diabetic foot ulcers in humans and discovery of a potent and selective small-molecule MMP-9 inhibitor that accelerates healing. J Med Chem, 2018, 61(19): 8825-8837.
17. 柯瑜君, 陳鷺, 林文謙, 等. 右美托咪定局部用藥對糖尿病足患者羅哌卡因坐骨神經阻滯半數有效濃度的影響. 福建醫科大學學報, 2020, 54(3): 192-195.
18. 何夢龍, 葉琪毅, 劉文革, 等. 超聲清創聯合濕潤包扎在糖尿病足保肢治療中效果研究. 中國現代藥物應用, 2020, 14(7): 62-63.
19. 何夢龍, 葉琪毅, 劉文革, 等. 超聲清創聯合負壓引流技術治療糖尿病足潰瘍臨床分析. 嶺南急診醫學雜志, 2020, 25(2): 181-183.
20. Bajpai A, Nadkarni S, Neidrauer M, et al. Effects of non-thermal, non-cavitational ultrasound exposure on human diabetic ulcer healing and inflammatory gene expression in a pilot study. Ultrasound Med Biol, 2018, 44(9): 2043-2049.
21. 吳顯惠. 超聲清創在糖尿病足病換藥中的應用. 名醫, 2020(10): 214-215.
22. Esposito S, De Simone G, Gioia R, et al. Deep tissue biopsy vs. superficial swab culture, including microbial loading determination, in the microbiological assessment of skin and soft tissue infections (SSTIs). J Chemother, 2017, 29(3): 154-158.
23. Koreyba KA, Kudykin MN, Minabutdinov AR. Treatment of wound defects in patients with neuroischemic form of diabetic foot syndrome. Khirurgiia (Mosk), 2015(7): 69-74.
24. 楚偉英, 葉貞, 鄧博, 等. 超聲清創結合局部氧療治療糖尿病足 Wagner2 級創面的效果觀察. 廣東醫科大學學報, 2020, 38(1): 67-69.
25. 林雙, 袁麗, 楊小玲, 等. 超聲水刀聯合負壓滴灌治療在慢性難愈性糖尿病足中的應用效果. 四川醫學, 2019, 40(7): 718-722.
26. 李丙蓉, 侯麗梅, 劉瑤麗, 等. 超聲水刀清創系統聯合封閉式負壓引流沖洗在慢性糖尿病足創面治療中的應用. 解放軍醫藥雜志, 2020, 32(9): 30-33, 43.
27. 籍胤璽, 金毅, 金文波. 封閉式負壓引流聯合超聲清創術治療糖尿病足潰瘍的療效. 中國現代醫學雜志, 2019, 29(1): 108-112.

West China Medical Journal

Clinical study of ultrasonic debridement combined with autolytic debridement in the treatment of diabetic foot ulcers

Abstract Full text Figures/Tables Video References Cited by

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